Rare bleeding source in esophageal carcinoma - a case of upper gastrointestinal hemorrhage from intercostal artery pseudoaneurysm: A case report and literature review.

RATIONALE: Transcatheter arterial embolization (TAE) serves as a critical intervention for upper gastrointestinal bleeding (UGIB) when endoscopic therapy fails or the bleeding source cannot be localized. The intercostal artery is an exceedingly rare source vessel for UGIB. This report describes a case of UGIB caused by a pseudoaneurysm of the left intercostal artery in a patient with esophageal carcinoma, along with a review of the relevant literature.

PATIENT CONCERNS: The patient presented to our hospital due to UGIH.

DIAGNOSES: UGIH.

INTERVENTIONS: After admission, failure of medical therapy prompted emergency endoscopy, which revealed an active pulsatile bleeding. Following unsuccessful endoscopic hemostasis, emergency TAE was performed, achieving successful embolization of a pseudoaneurysm in the left intercostal artery.

OUTCOMES: Postoperatively, the patient's hemoglobin levels remained stable, and no further bleeding was observed.

LESSONS: Multidisciplinary collaborative management is essential for UGIB. TAE should be considered when conventional therapies fail. During TAE, if routine angiography of suspected culprit vessels yields negative results, a high index of suspicion for rare ectopic feeding arteries (e.g., intercostal arteries) is required. This case report aims to enhance the diagnostic and embolization proficiency of interventional radiologists in managing UGIB caused by such uncommon aberrant vessels.